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Background In 2005, the European Union (EU) started to use a disability-free life expectancy, known as Healthy Life Years (HLY), to monitor progress in the strategic European policies such as the 2000 Lisbon strategy. HLY are based on the underlying measure: the Global Activity Limitation Indicator (GALI). Twelve years after its implementation, this study aims to assess its current use in EU Member States and the European Commission. Methods In March 2017, a questionnaire was sent to 28 Member states and the European Commission. The questionnaire inquired how the GALI and HLY are used to set policy targets, in which surveys the GALI has been introduced since 2005, how the GALI and HLY are presented, and what the capacity in each country is to investigate the GALI and HLY. Results The survey was answered by 22 Member States and by the Commission. HLY are often used to set targets and develop strategies in health such as national health plans. Analysis of HLY has even led to policy change. In some countries, HLY have become the main indicator for health, gaining more importance than life expectancy. More recently, the GALI and HLY have also been used for policy targets outside the health sector such as in the area of pension and retirement age or in the context of sustainable development. Regarding surveys, the GALI is mostly obtained from the EU-SILC, SHARE and EHIS, but is also increasingly introduced in national surveys. National health reporting systems usually present HLY on their national statistics websites. Most countries have up to three specialists working on the GALI and HLY, which has been consistent through time. Others have increased their capacity over various institutions. Conclusion HLY is an indicator that is systematically used to monitor health developments in most EU countries. The SHARE, EU-SILC and EHIS are commonly used to assess HLY through the GALI. The results are then described in reports and presented on national statistics websites and used in different policy settings. Expertise to analyse the GALI and HLY is available in most countries. Electronic supplementary material The online version of this article (10.1186/s13690-018-0279-z) contains supplementary material, which is available to authorized users.

Introduction – Les troubles neuro-psychiatriques constituent une des principales causes de morbidite et d'incapacites liees au vieillissement. Le projet Esprit a pour but d'etudier l'etiologie complexe des troubles psychiatriques chez le sujet âge pour une meilleure prise en charge. Objectifs – 1) determiner la prevalence (en actuel et au cours de la vie) et l'incidence des troubles psychiatriques en population generale âgee ; 2) evaluer les facteurs de risque de ces troubles, leur poids relatif et leurs interactions ; 3) etudier l'heterogeneite clinique ; 4) estimer les probabilites de transition vers un etat subsyndromique ou vers la maladie ; 5) construire des modeles etiologiques predictifs. Methode - L'etude longitudinale Esprit porte sur 1863 personnes non institutionnalisees de 65 ans et plus, recrutees par tirage au sort sur listes electorales. Depuis l'inclusion en 1999, ces sujets ont deja ete revus deux fois a 2 ans d'intervalle. Ils ont ete soumis a differents questionnaires (socio-demographiques, antecedents medicaux, incapacites, expositions, survenue d'evenements traumatiques), examens neurologiques ainsi qu'a un enregistrement polysomnographique a domicile. Une DNAtheque et une serotheque ont ete constituees et certains parametres biochimiques doses (lipides, cortisol...). La pathologie psychiatrique a ete evaluee au cours d'un entretien structure, le MINI (fonde sur les criteres diagnostiques du DSM IV), la symptomatologie depressive par la CES-D et le niveau d'anxiete via l'echelle de Spielberger. D'autres questionnaires ont ete utilises afin d'evaluer la personnalite colerique (Spielberger-anger), l'impulsivite (Barratt), l'agressivite (Buss-Durkee) et la survenue de traumatismes dans l'enfance. Resultats - Les troubles psychiatriques sont frequents chez les sujets âges et au cours de leur vie ils ont touche pres d'une personne sur deux. La prevalence des troubles actuels est elevee notamment pour les phobies (10,7%), l'anxiete generalisee (4,6%) et les ideations suicidaires (9,8%). Pour la plupart des troubles psychiatriques, les prevalences sont pres de 2 fois plus elevees chez la femme. Nos premieres analyses montrent l'importance de certains facteurs de risque jusque-la peu explores, facteurs environnementaux comme les evenements de vie traumatiques ou facteurs biologiques comme le statut hormonal au cours de la vie reproductive ou le role des systemes de regulation du stress (e.g. activite secretoire de l'axe HPA). L'insomnie est egalement un facteur de risque de troubles depressifs ou anxieux. Conclusion - L'etude longitudinale Esprit constitue une base de donnees relativement exhaustive sur les troubles psychiatriques en population generale francaise âgee. L'approche multifactorielle (prenant en compte facteurs environnementaux, psychosociaux, biologiques, genetiques, pharmacologiques ou cliniques et leurs interactions) devrait permettre la construction de modeles etiologiques complexes susceptibles d'etre valides au sein d'etudes cliniques et ouvrir de nouvelles perspectives dans le champ de la sante mentale du sujet âge.

BackgroundFrance has high rates of psychotropic drug consumption and suicide in the elderly population, but it has not yet been possible to determine whether this is due to exceptionally high morbidity rates.AimsTo describe the first longitudinal population study of psychiatric disorder undertaken in France, and to estimate current and lifetime prevalences and age of onset of psychiatric disorder.MethodA study group of 1873 non-institutionalised persons aged 65 years and over was randomly recruited from the Montpellier district electoral rolls. The Mini International Neuropsychiatric Interview was used to assess current and lifetime symptoms. Cases identified by the application of DSM–IV criteria were reexamined by a clinical panel.ResultsForty-six percent of the study population had experienced a mental disorder in their lifetime, and 3.7% had made a suicide attempt. Lifetime prevalence of major depression was 26.5% and 30% for anxiety disorders. Current prevalence rates were 14.2% for anxiety disorders, 10.7% for phobia, 3% for major depression and 1.7% for psychosis.ConclusionsResults show very high rates of lifetime but not current major depression. Rates of current phobia and suicidal ideation in the very elderly are also high compared with other studies. The rates reported are likely to be underestimates.

Since the 1990s, several studies involving French centenarians have shown a gender paradox in old age. Even if women are more numerous in old age and live longer than men, men are in better physical and cognitive health, are higher functioning, and have superior vision. If better health should lead to a longer life, why are men not living longer than women? This paper proposes a hypothesis based on the differences in thegenerational habitusbetween men and women who were born at the beginning of the 20th century. The concept ofgenerational habituscombines the generation theory of Mannheim with thehabitusconcept of Bourdieu based on the observation that there exists a way of being, thinking, and doing for each generation. We hypothesized that thishabitusstill influences many gender-linked behaviours in old age. Men, as “oaks,” seem able to delay the afflictions of old age until a breaking point, while women, as “reeds,” seem able to survive despite an accumulation of health deficits.

BackgroundElevated cortisol levels due to hypothalamic–pituitary–adrenal (HPA) axis stress response have been associated with cognitive impairment. However, the causal relationship between stress and subsequent cognitive impairment remains unclear, notably because of the small number of gender-stratified prospective studies.MethodSalivary cortisol secretion was evaluated in 197 non-depressed community-dwelling elderly people at three time points on the day of hospital attendance for a clinical examination and again on the following day at home, in a distinct environmental context. Cognitive performance was evaluated at baseline and at 2- and 4-year follow-up.ResultsCross-sectional logistic analyses adjusted for age and education indicated that men with high morning cortisol at the hospital had higher risk of low cognitive performance in verbal fluency [odds ratio (OR) 3.0, p=0.05] and visuospatial performance (OR 5.1, p=0.03). Impairment in verbal fluency was observed in women with moderate high morning cortisol (OR 3.6, p=0.05) or moderate slow diurnal rhythm (OR 3.7, p=0.04). In longitudinal analyses, slow diurnal rhythm (flatter slope) was associated with decline over 4 years in visuospatial performance (OR 7.7, p=0.03) and visual memory (OR 4.1, p=0.03) in men, and in verbal fluency (OR 6.0, p=0.01) in women. High morning cortisol was associated with decline in visual memory in women (OR 5.1, p=0.06).ConclusionsHPA axis dysregulation seems to be associated with low cognitive performance in the elderly. Slower cortisol elimination rates could predict cognitive decline affecting principally non-verbal functioning in men and verbal functioning in women. The effects are independent of environmental context, apolipoprotein E (ApoE) genotype or psychopathology. Interventions blocking this pathway may provide new therapeutic options to prevent cognitive decline.

International audience; BACKGROUND: Cortisol hypersecretion is characteristic of acute clinical depression, but little is known in fully recovered, non-treated elderly persons with a lifetime history of depression. This study was designed to examine patterns of diurnal cycle of cortisol in an elderly cohort without current depression or treatment for depression according to whether the person has or has not experienced a previous episode of depression or co-morbid depression with anxiety. METHODS: Cortisol secretion was evaluated in 162 community-dwelling elderly on a stressful and a non-stressful day (basal level). Past depression and anxiety disorders were assessed using a standardized psychiatric examination based on DSM-IV criteria (the Mini International Neuropsychiatric Interview). RESULTS: Antidepressant-free persons with a history of non-co-morbid major depression (6.8% of the sample) showed basal cortisol hypersecretion compared to those with depression and anxiety (8.6%) or controls. Several hours after exposure to a stressful situation, controls showed a sustained increase in cortisol secretion, which was not observed in persons with a history of depression. Persons with a history of depression with anxiety showed a similar cortisol secretion at baseline to controls but a heightened response to stressful situation; a pattern comparable to that observed in subjects with pure anxiety disorders (16.7%). CONCLUSION: An abnormal HPA response persists even after effective treatment for depression. A history of co-morbid depression and anxiety gives rise to changes characteristic of anxiety alone. Our findings suggest that cortisol abnormalities may be trait markers for vulnerability to depression and for the differentiation of depression and depression with co-morbid anxiety.

International audience; BACKGROUND: Cortisol secretion in elderly persons with anxiety disorders exposed to common stressful situations has not been evaluated. METHODS: Salivary-free cortisol levels were evaluated at 8, 15, and 22 h, in 201 elderly subjects during stressful and non-stressful days. Psychiatric symptomatology was assessed by a standardized psychiatric examination (MINI). RESULTS: Elderly subjects without psychiatric disorder showed a sustained increase in cortisol secretion several hours after the exposure to a stressful situation. In comparison, subjects with anxiety disorders showed a greater increase in cortisol secretion in the stressful situation, with lowered recuperation capacity. This effect was dose-dependent as a function of anxiety co-morbidity. Persons reporting lifetime major trauma with intrusions exhibited lowered continuous basal cortisol associated with efficient recuperation capacity. Independently of psychopathology, women appeared more reactive to stressful environmental conditions. LIMITATIONS: Exclusion of institutionalized persons and benzodiazepine users may have led to sampling of less severe anxiety symptoms. CONCLUSIONS: Dysregulation of the hypothalamic-pituitary-adrenal axis was observed in elderly persons with anxiety disorders experiencing environmental stress. A common pattern of up-regulated diurnal cortisol secretion was observed in anxious subjects with lifetime and current anxiety disorder irrespective of sub-type (generalized anxiety, phobias) suggesting a stable trait and a common "core" across disorders. Elderly persons who had experienced trauma with subsequent intrusions showed a distinct pattern with down-regulated activity.